Understanding Medicines: Insulin
Insulin and Other Injectables: At a Glance
Why do I need to take insulin but other people with diabetes don't?
If you have type 1 diabetes, your body is not able to produce insulin. Without insulin there is no way for
the excess glucose that occurs in the blood, especially after a meal, to be transported from the blood
stream to the cells where it is used to produce energy. The glucose builds up in the blood to very high
and dangerous levels that can have dire consequences. Those with type 1 diabetes take insulin through
injections or by using an insulin pump.
If you have type 2 diabetes you may also need insulin but for different reasons. Often
people with type 2 diabetes can continue to produce an adequate amount of insulin to meet
their body's needs for some time after they are diagnosed, while others need to start
insulin sooner. The results of your glucose self-monitoring, along with the results of
the A1C test, will help your health care provider decide what treatment is right for you.
Whether or not you take insulin does not decide what type of diabetes you have. The type
of diabetes you have depends on the causes of your diabetes.
I've heard that there is an insulin pill, is that right?
No, currently there is no oral (pill) form of insulin. Insulin is a protein, so oral insulin would be
broken down during digestion before it could get into the blood stream to help lower glucose levels.
Researchers are currently working on newer forms of oral insulin but human trials are still a few
years away. Currently, the only forms of insulin available for those with diabetes who need it are
injected or pumped.
Is it true that insulin causes complications?
No, this is not true. In the past, insulin often wasn't started in people with type 2 diabetes until late in their disease process, often after complications from high blood glucose levels had begun. Today we know that if you control the blood glucose earlier in the disease, you can actually prevent or delay some of the health related issues that can happen with uncontrolled blood glucose levels. Talk to your health care provider or diabetes educator about insulin therapy. They can answer your questions and help calm some of the fears you may be having about starting insulin.
I’ve heard that insulin injections hurt.
With the newer products on the market today, giving an injection can be near painless. The needles are smaller and sharper and many people say that they actually feel the insulin injection less than doing a finger stick to check their blood glucose. Insulin and other injectable medicines for diabetes are given into the fatty tissue just below the skin and not into muscle tissue, often resulting in a less painful injection.
Does it mean I've failed if I have to start taking insulin when I didn't need it before?
No, you have not failed. Diabetes is a chronic and progressive disease meaning that the longer you have it
the more likely you are to need changes in your treatment plan to continue keeping your blood glucose in a
target range. Your pancreas, over time, may have trouble keeping up with the insulin needs of your body and
your blood glucose levels begin to rise despite your best efforts. Taking insulin can help get glucose
levels back in target and help you to feel better.
Insulin
Characteristics
The insulin that you take by injection or through a pump works like your body's own insulin to lower your blood glucose. Insulin has three main characteristics: Onset, Peak time and Duration. Let's look at these a little closer.
Onset: The time it takes for the insulin to get to the blood stream and start lowering
your blood glucose
Peak time: The time when the insulin is at its maximum strength at lowering your blood
glucose.
Duration: The length of time the insulin works at lowering your blood glucose
Types of Insulin
Rapid-acting and short-acting insulin are considered bolus insulin and are taken before
a meal. Rapid-acting insulins are taken right before the meal and short-acting (regular)
insulin is taken 30-45 minutes before you plan to eat. These insulins start working as
the blood glucose begins to rise from your meal.
Intermediate and long-acting insulin are called basal insulin and stay in the body longer.
Intermediate insulin works all day if taken in the morning or all night if taken in the
evening. Long-acting insulin is usually taken once a day at any time as long as it is
taken at about the same time each day. Long-acting insulin works throughout the day and
night.
| |
Onset |
Peak |
Duration |
| *Important Note: glargine and detemir cannot be mixed with any other types of insulin in the same syringe
|
| Rapid Acting |
- lispro (Humalog®)
- aspart (Novolog®)
- glulisine (Apidra®)
|
15 mins. or less | 1 hour | 2-4 hours |
| Regular/Short Acting |
|
|
30 mins. to 1 hr. | 2-3 hours | 3-6 hours |
| Intermediate Acting |
|
|
2-4 hours | 4-12 hours | 12-18 hours |
| Long Acting |
|
|
1-2 hours | none | approx. 24 hours |
|
|
1-2 hours | relatively flat | up to 24 hours |
Pre-mixed Insulins
There are a variety of insulin preparations which combine different types of insulin in one vial, cartridge or pen and these are called pre-mixed insulins. They are useful for those with visual or dexterity problems and those that need to take two kinds of insulin at the same time. The action times for these insulins will depend on the type and amount of each insulin in the mixture.
Types
Humulin 70/30, Novolin 70/30 and Humulin 50/50 - each contain mixtures of short acting and
intermediate acting insulin.
Humalog Mix 75/25 and Novolog Mix 70/30 - each contain a mixture of rapid acting and
intermediate insulin.
Note:
Many of the insulin preparations discussed here are available in a
convenient dosing pen. Ask your pharmacist or health care provider for more
information about this option.
Hypoglycemia (low blood glucose)
Using insulin raises your risk of having hypoglycemia or a low blood glucose.
To help prevent this from happening:
- Eat your regular meals or snacks on time.
- Check your blood glucose more frequently when you are more physically active than usual.
- Know the action of the insulin you are using, especially the peak time since this is
when you may be more likely to experience a low blood glucose.
- Plan ahead; keep something with you at all times to treat low blood glucose.
If you feel symptoms of low blood glucose such as shaking, sweating, hunger or nervousness, check your
blood glucose immediately. If your blood glucose is below 70 mg/dL or below your target range, use
the "Rule of 15." Take 15 grams of carbohydrate such as 3-4 glucose tablets or 5-6 hard candies or 4 oz.
of juice or regular soda, wait 15 minutes and check your blood glucose again. Repeat until your blood
glucose is at least
70 mg/dL. Talk to your health care provider at your next visit if you are experiencing episodes of low
blood glucose; they may make changes to your treatment plan.
TIPS
- Always check the expiration date on your insulin.
- Check manufacturer's suggestion for storing open and unopened insulin.
- Keep insulin out of direct sunlight and heat. Keep insulin in a cool pack when
traveling.
- Don't freeze insulin.
- Check that your insulin looks normal before using: it should look clear for
glargine, detemir, regular, lispro, aspart and glulisine. NPH and any pre-mixed
insulin that contains NPH insulin will look cloudy and the bottle, pen or
cartridge will need to be gently rolled in your hands before drawing up the dose
into the syringe or using the pen.
- Use needles only once for injecting insulin and discard them in a safe manner.
A #2 plastic container such as a liquid detergent or bleach bottle works well.
Check with your town or state about rules for disposing of used needles and
syringes
Other Injectables:
Exenetide (Byetta): An injectable medication, not insulin, which is used twice a day to help lower blood
glucose after a meal in people with type 2 diabetes. Exenatide can be used with certain other diabetes
pills. It is used twice a day before breakfast and the evening meal and works to lower the blood glucose
only when it is elevated. If you skip the meal you do not take the medication as this may put you at risk
for low blood glucose. This medication has been shown to cause weight loss in some people. It may cause you
to feel full sooner and you may eat less food. It can also cause some mild to moderate nausea, which
improves over time. You don't need to adjust the dose of this medication and it comes in a convenient
dosing pen.
Pramlintide acetate (Symlin): An injectable medication, not insulin, used by both those
with type 1 or insulinusing type 2 diabetes. It is used with insulin at mealtimes to help lower your
after-meal blood glucose level. It can put you at a higher risk for low blood glucose, so insulin doses
may need to be adjusted accordingly. Nausea is the most common side effect with this medication and is
more likely to happen during the first few weeks of therapy. Pramlintide comes in a convenient dosing pen.
The information presented here is meant to be strictly for informational and educational
purposes. It is not to be considered as advice, including medical advice, from Liberty
Medical Supply, Inc. None of the information is intended to serve as a substitute for
diagnosis from, or consultation with, a health care professional. Always consult your
doctor regarding any medical questions that you have, as well as before starting or
changing your exercise or diet program, and before adjusting any medication.
†
Meter offer available to qualified beneficiaries with diabetes. Not available to current Liberty
patients. No purchase necessary. Meter shown for illustrative purposes only. Meter offer not
applicable to all brands of meter. Commemorative keychain offer and free HealthMatters subscription dependent
on patient enrollment. Combined offer available while supplies last. Terms and conditions apply.
* Up to 90 days from shipment (a longer period may apply based on law or regulation). Some
restrictions apply. We are unable to accept returns of properly filled prescriptions.
